By
Diana Hsieh

My vitamin D level was only 30 ng/mL. That is after over a year of supplementing with cod liver oil, which has 500 IU per 1/2 tsp. I take around 2 tsp. at a time, or 2000 IU. This was also after several sessions of sitting out in the sun this spring at high altitude, 8400 feet. Granted, I have not taken the cod liver oil religiously every day. However, my diet is very good (raw milk, eggs, meat, occasional liver [very high in vitamin D!!]) and although food is not a sufficient source of vitamin D, I probably get around 400IU daily in my food, the government's recommended level.

As Monica observes, while 30 ng/mL isn't awful, something more like 60 to 80 ng/mL seem to be required for robust health. Happily, my vitamin D test showed 88 ng/mL. Notably, that was after a few months of serious supplementation with cod liver oil and D tablets -- 3,000 IU to 5,000 IU per day, in addition to some time outside in the sun.

Mayo Clinic research shows a correlation between inadequate vitamin D levels and the amount of narcotic medication taken by patients who have chronic pain. This correlation is an important finding as researchers discover new ways to treat chronic pain. According to the Centers for Disease Control and Prevention, chronic pain is the leading cause of disability in the United States. These patients often end up taking narcotic-type pain medication such as morphine, fentanyl or oxycodone.

This study found that patients who required narcotic pain medication, and who also had inadequate levels of vitamin D, were taking much higher doses of pain medication -- nearly twice as much -- as those who had adequate levels. Similarly, these patients self-reported worse physical functioning and worse overall health perception. In addition, a correlation was noted between increasing body mass index (a measure of obesity) and decreasing levels of vitamin D. Study results were published in a recent edition of Pain Medicine.

That result isn't terribly surprising: doctors have long known about the importance of vitamin D to musculoskeletal health. (The extreme form of vitamin D deficiency is rickets.) Moreover, a 2003 study showed that 93 percent of subjects with non-specific musculoskeletal pain were vitamin D deficient. (That report doesn't say what constituted Vitamin D deficiency for the purpose of the study, but I imagine that it was less than 20 ng/mL, at least. Some people in the study had zero vitamin D!)

Please do note that both of these reports concern observational studies: they show correlation, not causation. However, the connection between chronic pain and vitamin D is clearly an issue worthy of further scientific study.

Saturday, March 21, 2009

By
Diana Hsieh

The Wall Street Journal reports on the return of lard, i.e. pork fat, in cooking in the article Big Fat Deal. Here's a bit from the middle:

Lard's redemption is also driven by a shift in culinary thinking that suggests it is not as unhealthy as some people think. One of the primary evangelists is the Weston A. Price Foundation, a small Washington, D.C.-based group that has promoted lard's unlikely health benefits for the last decade. Lard has also benefited from movements like sustainable agriculture, which preaches against allowing any part of an animal going to waste.

Lard didn't always have such a bad reputation; a century ago, most Americans cooked with it. But when the vegetable-based shortening Crisco came out in 1911, it saw lard as a major competitor. Procter & Gamble, Crisco's creator, denigrated lard in its Crisco marketing, discussing its "lardy, greasy taste" and calling it indigestible. Its popular cookbook, "The Story of Crisco" was full of illustrations like one comparing a smoke-filled "lard kitchen" to a gleaming "Crisco kitchen."

The result was that a cook who used lard came to be seen as "someone who was uneducated, who was dirty, unscientific, lived on a farm," says Sally Fallon, president of the Price Foundation. Then came health campaigns against saturated fats and cholesterol, compounding the unflattering image and effectively banishing lard from U.S. kitchens for decades.

But lard's reputation is undeserved, says Ms. Fallon. While she doesn't advocate supermarket lard, which typically has extra hydrogen pumped in to extend shelf life, she says natural, minimally processed lard is good for you. It contains up to 60% monounsaturated and polyunsaturated fats--the "good" fats that have beneficial effects on cholesterol. It also is high in vitamins A and D.

Unfortunately, the article doesn't mention Fallon's view that saturated fat isn't a health risk but rather a positive good.

For more on the benefits of cooking with lard, Dr. M.D. Eades wrote an excellent post in defense of lard a few months ago. In it, she compares the composition of lard to other fats widely regarded as healthy -- and lard does very well by every reasonable measure.

By coincidence, that blog post by Dr. Eades was inspired by a news article that confused hydrogenated vegetable shortening with lard. Similarly, the above Wall Street Journal referred to "five quarts of a type of lard from cows known as beef tallow" in its last paragraph. But tallow (i.e. beef fat) is not a kind of lard (i.e. pork fat). It's a sad sign of the culinary times that people don't know what the word "lard" means. But happily, that seems to be changing.
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By
Diana Hsieh

Fish oil has become a fairly standard dietary supplement in the last few years, particularly for its cardiovascular benefits. My goal in this post is not to analyze those studies, but rather to consider the nuts and bolts of extracting genuine benefits from fish oil, based on my own readings on the topic. I'm not an expert, obviously, just a curious layman.

First: Dosage.

Not too long ago, Dr. Davis, the Heart Scan Doc, wrote a very helpful post on getting your dose of fish oil right. In essence, you need to look at the EPA and DHA numbers, add them together, then multiply that sum by the servings of capsules that you take per day. Dr. Davis writes:

What should the total daily dose of EPA + DHA dose be? That depends on what your goals are.

If your goal is to modestly reduce the risk of dying from heart attack, then just eating fish a couple of times per month will begin to exert an effect, or just taking a dose of 300 mg EPA + DHA per day from a low-potency capsule will do it. However, that's an awfully unambitious goal.

Our starting omega-3 dose in the Track Your Plaque program has, over the years, increased and now stands at 1800 mg EPA + DHA per day. However, the dose for 1) full reduction of triglycerides and/or triglyceride-containing abnormal lipoproteins, 2) reduction of Lp(a), and 3) the ideal dose for coronary and carotid plaque control are substantially higher.

I've spent way too much time in Whole Foods examining the labels of various kinds of fish oil. My conclusions are two: (1) the EPA + DHA of many fish oils is shockingly low and (2) the total EPA + DHA varies wildly independent of price. The highest numbers I've seen so far are in the ProOmega fish oil sold by Dr. Eades. It has 450 mg DHA and 650 EpA per two-capsule serving. (Nope, I don't benefit from sales of that in the slightest.)

Second: Storage.

In addition to EPA + DHA content in your fish oil, you should worry about the strong possibility of rancid fish oil. Here's what Dr. Eades says about the danger:

Fish oil is primarily EPA and DHA, both of which are extremely unsaturated. And, as we all know, the greater the degree of unsaturation, the greater the propensity to go rancid. When these oils go rancid (or "go off" as the Brits put it) they don't go from being healthful to simply becoming neutral, they actually convert to harmful oxidized fats called lipid peroxides.

Lipid peroxides can (and do) start free radical cascades that can damage fatty cellular membranes. At the very least lipid peroxides consume the body's stores of vitamin E and other antioxidants to neutralize them, leaving the body short of many of its natural defenses.

You can prevent it by taking some simple steps. Dr. Eades writes:

How do you insure that the fish oil you get is not rancid? It's actually pretty easy.

First, purchase the freshest fish oil capsules you can find. Take them home, and if they are in plastic bottles, put them in glass bottles. Plastic bottles, surprisingly enough, are not totally impervious to air. Glass bottles are impervious to air. Most fish oil is encapsulated using gel caps, which are also not impervious to air. You can't really reencapsulate the fish oil, so you've got to live with the gel caps, but putting them into a glass bottle keeps the air from getting to the gel caps in the first place.

Second, put the glass bottle in the refrigerator. The cold will markedly slow down the oxidation process even if a little air gets in the bottle. Refrigerated fish last a lot longer than fish left out on the counter.

The final step you can take to insure freshness of your fish oil capsules is to bite into one and chew it. If it is rancid, you'll know it. If it is, throw the whole batch out. If you perform the chew test every four or five days, you'll always know you're taking unrancid fish oil.

I keep my fish oil in the fridge, but I ought to transfer it to a glass jar. I should also make a habit of doing a chew test once a week. That sounds icky, but I will hope that fish oil is only disgusting when rancid. After all, I have no problem taking my spoonful of straight cod liver oil each day, also kept in the fridge, along with the butter oil. Now that I consider the matter, however, it would be easier (and likely cheaper) to switch to the liquid form of fish oil -- like Nordic Naturals Omega 3D -- once I used up my current supply of capsules.

Third: Ratios

From what I've read, the critical issue with omega-3 fatty acids is not your absolute intake, but your omega-6 to omega-3 ratio. Stephan of Whole Health Source argues -- and rightly so, I think -- that a healthy omega-6: omega-3 ratio is somewhere between 2:1 and 1:4. By way of contrast, the ratio in the American diet today is around 16:1.

As the charts in Stephan's post show, limiting your omega-6s requires avoiding vegetable oils, except palm and coconut oil. Animal fats are far preferable -- particularly beef, lamb, and pork fat rather than chicken and turkey fat. In practical terms, that requires strictly limiting conventionally-prepared fried foods, mayonnaise, salad dressings, and the like found in grocery stores and restaurants. If you're willing to take a bit of trouble, however, you make and enjoy healthy versions of these foods at home using good fats.

If you'd like to know more about omega-3 and omega-6 fats, I recommend Stephan's whole series on the subject, to which I've linked before:

Finally, I'd like to recommend Richard Nikoley's post on diet supplements. (That's a link to Part 4, but he summarizes and links to the prior parts in the introduction.) I agree with his general principle that "supplementation ought to be the exception, not the rule, and there ought to be clear reasons for supplementing." I also think his particular recommendations of Vitamin D (in the form of D3), fish oil, and K2 (whether via butter oil or in a synthetic form) are very sensible.
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Saturday, March 14, 2009

By
Diana Hsieh

Unfortunately, I don't have time to blog anything substantial right now, so you will have to content yourself with some very interesting blogging from Stephan of Whole Health Source, namely his excellent series on the Tokelau Island Migrant Study.

Saturday, March 07, 2009

By
Diana Hsieh

New research suggests that campaigns to promote exercise may have an unintended consequence: they make people eat more.

In a study in the March issue of the journal Obesity, 53 college students were asked to judge a series of posters drawn from an actual exercise campaign and, on another occasion, a group of similar-looking posters that did not mention exercise. They were told they would be given a few raisins afterward, which they were to taste and rate. After the students looked at the exercise posters, they ate an average of 18 calories, but they ate only 12 calories after viewing the posters with no mention of exercise.

In a second test, 51 different students, told they were participating in a computerized test of hand-eye coordination, were randomly assigned to be exposed to action words like "active" and "go" typically used in exercise advertising. A control group was exposed to neutral words, like "pear" or "moon." Again, they were offered food (peanuts, raisins and M&M's this time) and the results were similar: those who heard the action words ate more.

Dolores Albarracin, the lead author and a professor of psychology at the University of Illinois, Urbana-Champaign, said that context was important. "When the setting of the advertising is more conducive to eating than exercise, people eat," she said. "If you just wallpaper everyplace with these kinds of posters, it may not do much good."

"Sodium makes your heart beat faster, so it can create something really serious," said Greye, who is 8 years old and lives in Mays Landing, N.J.

Greye's mother, Beth Dunn, the president of a multimedia company, is proud of her son's nutritional awareness and encourages it by serving organic food and helping Greye read labels on cereal boxes and cans.

"He wants to be healthy," she says.

Ms. Dunn is among the legions of parents who are vigilant about their children's consumption of sugar, processed foods and trans fats. Many try to stick to an organic diet. In general, their concern does not stem from a fear of obesity -- although that may figure into the equation -- but from a desire to protect their families from conditions like hyperactivity, diabetes and heart disease, which they believe can be avoided, or at least managed, by careful eating.

While scarcely any expert would criticize parents for paying attention to children's diets, many doctors, dietitians and eating disorder specialists worry that some parents are becoming overzealous, even obsessive, in efforts to engender good eating habits in children. With the best of intentions, these parents may be creating an unhealthy aura around food.

From my perspective, the problem is not that parents are attempting to steer their kids toward healthy foods. Parents ought to do that: they ought to feed their kids foods that nourish and sustain them, as well as to teach them the principles and habits of good eating. The problem here is that some parents seem to be imposing a strict dietary regimen on their children as a duty disconnected from facts -- and disconnected from the child's own understanding. That duty-based approach will do psychological damage, whether the recommended diet is sound or not.

The proper response to that problem is not to say "eat in moderation" or "don't be so fussy" or "lighten up." Nutrition is a science: the human body is not mere mere subjective phenomena, capable of being stuffed full of anything without ill effect. As a matter of objective fact, some foods are healthy and others are not. As a matter of objective fact, some foods should be eaten in abundance, others in moderation, others rarely, and others not at all. The proportions may often depend on the individual, but even then, facts are facts.

A person can do him self very real damage by eating the wrong kinds of foods. Personally, if I attempted to eat sweets "in moderation," I would suffer for it. I would start feeling run down. I would be constantly hungry. I would have persistent cravings for more sugar. I would regain weight. My fasting blood glucose would rise again, meaning that I'd be on my way to type 2 diabetes. My liver would get fatty again -- or fattier. My HDL levels would decline, and my triglycerides would rise. All of that would be very bad for me, and that's a matter of fact.

So for me to refrain from eating sweets is right and proper. Frankly, I'm even discovering that the ill effects I feel from eating just one brownie once a month are not worth the pleasures of it on my tongue. Do I flog myself for eating that once-a-month brownie? Of course not. I simply observe those ill effects and remind myself to choose more carefully next month. It's too bad that I'm so sensitive, and I'm well aware that others are more tolerant of sugar than me. But I'm not going to beat my head against a wall: my job as a person is to live in reality in accordance with the facts, whether I like them or not.

The only real solution to the problem of this new neurosis about food is to banish the duty-based approach to eating in favor of a fact-based approach. A person's dietary choices should be based on his first-handed understanding of the facts. That means understanding the actual science of nutrition -- opposed to the conventional wisdom. (For that, I think, a person simply must read Gary Taubes' Good Calories, Bad Calories.) And, in conjunction, a person must track the effects of his diet on his day-to-day well-being to determine what kinds of foods benefit versus harm him. That often requires some substantial work of discovery: it's usually not obvious without some careful and sustained experimentation of one's own. Moreover, to be useful, such experiments should be guided by a person's well-grounded general knowledge of metabolism, nutrition, and the like.

In short, a person should fare better in perceptible ways on on any diet worth sustaining. That knowledge should be the basis for the person's nutritional choices, not mere dogma. If a person has that knowledge, then for him to insist on his food choices -- however fussy, however demanding, however contrary to conventional wisdom -- is right and good. Such a person is acting in his self-interest, based on his own independent judgment. And that's a good thing.
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